Assist-control ventilation vs. low levels of pressure support ventilation on sleep quality in intubated ICU patients

Abstract

ACV was significantly associated with a better sleep quality than those recorded during pressure support. The perception of sleep quality appeared to be better with ACV than with low PSV. On the basis of these results we recommend that intubated and mechanically ventilated patients for acute on chronic respiratory failure should be reventilated at night during their weaning period.

Effect of Ventilatory Variability on Occurrence of Central Apneas

“…Adding a mechanical dead space significantly decreased the number of central apneas: a finding that further supported overassistance as the cause of central apneas. 40,50 A study comparing PSV and the SmartCare automated weaning system in conscious unsedated patients showed similar numbers of central apneas. 51 SmartCare is an embedded version of the closed-loop NeoGanesh system, 52,53 which keeps the patient within the comfort zone (as defined by respiratory parameters) while gradually decreasing the level of pressure support to a minimal value, at which point a trial of spontaneous breathing is performed.…”

Examining the Evidence to Guide Practice: Challenging Practice Habits

“…Discomfort of the endotracheal tube, uncomfortable set respiratory rates, ventilator alarms, reduced total REM sleep, and dyssynchrony with the ventilator all contribute to sleep disruption. 44,46,47,51,73 Studies that explored the relationship between sleep and ventilator mode showed that sleep was less fragmented with assist-control ventilation or pressure-controlled ventilation than in pressure support mode. [73][74][75] Nurses play a vital role in improving their patient's sleep and limiting sleep disruption.…”

“…Reduce environmental noise (alarms, equipment, television, telephones, overhead pages, conversation) [43][44][45]51,64,67,69 Reduce light exposure during sleep time; dim lights 43,51,67 Provide patient and their family members with education about sleep promotion Consider ear plugs to reduce environmental noise 65,66 Regularly assess patients for delirium by using a valid and reliable tool 56 Promote a consistent sleep/wake cycle 53,56 Provide reorientation as needed 56 Provide hearing, vision, and communication tools as needed Implement nurse-driven early mobility protocols Assess for endotracheal tube discomfort 44 Limit dyssynchrony with the ventilator 44,75 Consider assist-control ventilation versus pressure support modes 73,74 Assess for medications that impair sleep: antipsychotics, β-blockers, proton pump inhibitors, H 2 blockers, antibiotics, antidepressants, corticosteroids, vasopressors, antiasthmatics, benzodiazepines, γ-aminobutyric acid agonists 45 Assess for medications that can cause withdrawal insomnia: sedatives, nicotine, alcohol, opiates 45 Ask the patient and/or family what the patient's regular sleep/wake cycle is to adapt care Promote consistent sleep and awake periods Encouraging activity helps with sleep hygiene 81 Limit use of sedatives when possible to promote improved sleep architecture 53,56,57 Limit the use of benzodiazepines 56,57 Assess the patient for signs of sleep deprivation and/or delirium 53,56,57 Use massage, music, acupressure, and/or aromatherapy to enhance relaxation 82,83 Assess the patient for sleep deprivation even if the patient appears to be sleeping (eg, eyes closed, vi...…”

Light Intensity on Intensive Care Units- A Short Review

“…Sleep deprivation and the inability to sleep are described by survivors as major sources of anxiety and stress during stays in the ICU [10][11][12][13][14]. Impaired circadian rhythm of melatonin secretion has been reported in sedated and mechanically ventilated patients in ICU [15].…”